Early hormone-positive breast cancers typically have favorable outcomes, yet long-term surveillance is crucial due to the risk of late recurrences. While many studies associate MMP-11 expression with ...poor prognosis in breast cancer, few focus on early-stage cases. This study explores MMP-11 as an early prognostic marker in hormone-positive breast cancers.
In this retrospective study, 228 women with early hormone-positive invasive ductal carcinoma, treated surgically between 2011 and 2016, were included. MMP-11 expression was measured by immunohistochemistry, and its association with clinical and MRI data was analyzed.
Among the patients (aged 31-89, median 60, with average tumor size of 15.7 mm), MMP-11 staining was observed in half of the cases. This positivity correlated with higher uPA levels and tumor grade but not with nodal status or size. Furthermore, MMP-11 positivity showed specific associations with MRI features. Over a follow-up period of 6.5 years, only 12 oncological events occurred. Disease-free survival was linked to Ki67 and MMP-11.
MMP-11, primarily present in tumor-surrounding stromal cells, correlates with tumor grade and uPA levels. MMP-11 immunohistochemical score demonstrates a suggestive trend in association with disease-free survival, independent of Ki67 and other traditional prognostic factors. This highlights the potential of MMP-11 as a valuable marker in managing early hormone-positive breast cancer.
Background Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumors of sweat glands having recurrence/metastatic potential. Objective We sought to describe the ...clinical/histopathological characteristics of a series of ADPA. Methods This is a retrospective case series of 19 ADPA. Results The tumors occurred in 17 men and 2 women (mean age: 47 years). They involved digits (15), big toe (3), and palm (1), and measured from 3 to 30 mm. They were mostly solid and cystic, with papillary projections and tubular structures. Atypia was mostly mild to moderate. Tumors tested positive for p63, keratin 7, keratin 77 (eccrine duct-specific), PHLDA1, and epithelial membrane antigen in most cases, and for carcinoembryonic antigen, smooth muscle actin, S100 protein, estrogen, progesterone, and androgen receptors in 50%. Mean Ki67 proliferation index was 15%. Local recurrence was observed in 4 cases. One patient had axillary lymph node metastasis. Histopathologic parameters were not predictive of evolution. Conservative surgical treatment, performed in 7 of 19 cases, did not result in more recurrences than amputation. Limitations The study was retrospective and the number of cases is small. Conclusion ADPA are histologically variable, but papillary projections are always present. Keratin 77 expression suggests an eccrine origin. P63 is helpful to exclude metastasis. Conservative surgery may be sufficient in some cases.
30% of the patients suffering from hyperoxaluria type 1 are diagnosed only when they already had reached end-stage renal disease. We report the case of a 57-year-old woman with history of chronic ...kidney failure presenting with paraplegia due to spinal cord compression by thoracic mass-like lesions. Bone biopsy specimen obtained by decompressive laminectomy revealed calcium oxalate deposits. Once diagnosis of primary hyperoxaluria was confirmed, she underwent haemodialysis with incomplete improvement of her neurological disorders and was registered on the waiting list for transplantation.
A 47-year-old woman with history of hepatocellular carcinoma was referred for
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F-fluorocholine PET/CT evaluation due to elevated alpha-fetoprotein. The examination showed several peritoneal uptakes ...and two nodular pelvic foci. Coelioscopic exploration allowed confirmation and resection of multiple peritoneal metastases from hepatocellular carcinoma while pelvic biopsies revealed endometriosis and endosalpingiosis. However, alpha-fetoprotein kept rising: subsequent
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F-fluorodesoxyglucose PET/CT exploration found no pelvic uptake, while
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F-fluorocholine PET/CT revealed intense tracer accumulation in the two pelvic masses corresponding to bilateral ovarian metastases of hepatocellular carcinoma. We highlight the importance of
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F-fluorocholine PET/CT in hepatocellular carcinoma especially in patients with confounding comorbidities such as endometriosis.
The discovery of exogenous particles in the broncho-pulmonary tree is frequently described in forensic literature, especially in lung samples, in the context of aspirated gastric content during the ...death agony period or during resuscitation. We report an original observation of a multi-visceral dispersion of exogenous particles detected, in an 8-year-old boy, who allegedly fell from a 2-m high brick-wall. The autopsy found major liver fracture and diaphragm rupture with massive internal hemorrhage without gastric wall rupture. The histological analyses have identified round to oval bodies in the lung bronchi, alveoli, and, rarely, in vascular sections, and also on the surface of several samples. These particles stained strongly pink by the periodic acid Schiff method, evoking dried vegetables. Two hypotheses were invoked: aspirated vegetable particles into the bronchial tree or parasitic infection, like pinworm larva. In order to characterize the nature of these particles, different legumes were cooked, embedded in paraffin wax, and examined under light microscope. Simultaneously, morphological comparison between the gastric content and pinworm larva and lentils was made and a PCR analysis was performed on gastric fluid sample. The DNA sequencing showed a Fabaceae plant family,
Lens culinaris
. The possibility of a hematogenous dissemination of the starch grains during a perimortem aspiration of gastric content seems unlikely, and a contamination from the gastric content of the organs samples during the autopsy or the pathologic macroscopic and microscopic processes seems to be the principal hypothesis. The formal identification of such particles is important to avoid the misdiagnosis of a potential parasitic infection. The risk of confusion can be detrimental in some circumstances.
There is a paucity of data to determine the optimal adjuvant treatment of early-stage, high-risk endometrial histologies. While many retrospective series focus on uterine serous cancer, the optimal ...treament for other high risk subtypes, including G3 endometrioid cancer, clear cell carcinoma or carcinosarcoma is not yet clear. We sought to determine patterns and outcomes of adjuvant treatment for early-stage high-risk endometrial cancers of multiple histologic subtypes.
After Institutional Review Board approval, a retrospective review of patients at Montefiore Medical Center diagnosed with early stage high-risk endometrial cancer between 2006 and 2018 was conducted. Inclusion criteria included: 1) Stage I-II disease 2) Grade 3 endometrioid, carcinosarcoma, clear cell, serous, or mixed histologies. Demographic and clinical information pertaining to cancer treatment was collected. The primary outcome was recurrence-free survival. Univariate and multivariate analyses were performed and a Kaplan-Meier progression free survival curve was created using STATA 14.2. P-value <0.05 was considered statistically significant.
A total of 1208 patients with endometrial cancer were identified, 249 of which met inclusion criteria. Sixty-percent (149) of patients had serous, clear cell, or mixed histologies, 17% (43) had carcinosarcoma, 23% (57) had Grade 3 endometrioid histology. Most patients received adjuvant combination chemoradiotherapy (52%, N=131) whereas 20% (49) received radiation alone (brachytherapy or external beam), 7% (18) received chemotherapy alone, and 20% (50) received no adjuvant treatment. Of the 48 (19%) disease recurrences, 25 (45%) were distant metastases at the time of recurrence. Combined chemoradiotherapy was associated with increased recurrence-free survival compared with chemotherapy alone (p=0.026) or radiation alone (p=0.004). Compared to G3 endometrioid histology, the hazard ratios for recurrence were: 3.70 (CI 1.31-10.41, p=0.01) for serous histology, 1.37 (CI 0.15-12.21, p=0.78) for clear cell, 9.70 (CI 3.22-29.16, p<0.01) for carcinosarcoma, and 4.59 (CI 1.28-16.46, p=0.02) for mixed histology. Charlson Cormorbidity Index was also associated with cancer recurrence (HR 1.53, CI 1.28-1.82, p<0.01), as was age (HR 0.95, CI 0.92-0.99, p=0.01).
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Multimodal treatment with chemotherapy and radiation therapy is associated with increased recurrence free survival in patients with high-risk early-stage endometrial cancers, in comparison to radiation or chemotherapy alone after surgical staging. Histologic subtype, comorbid conditions, and age all significantly impact survival. Notably, recurrence in clear cell tumors were not significantly impacted by adjuvant treatment with chemotherapy and radiation therapy. Randomized trials are needed to determine the optimal treatment of high-risk histologic subtypes.
For over a decade palliative medicine in conjunction with disease modifying therapy has been recommended for women with metastatic, recurrent and symptomatic malignancies. The objective of this study ...was to compare the prevalence of palliative care consultations as well as aggressive care at the end of life (ACE) scores between women who died from gynecologic malignancies from 2005-2010 verse 2015-2020 as stratified by timely verses no/untimely consultation. We hypothesize that in the past fifteen years there has been an increase in palliative medicine consultation.
After IRB approval data including patient demographics, histopathology, treatment and metrics of quality palliative care were abstracted from patients who died from gynecologic malignancies between 2005-2010 and 2015-2020 at a tertiary care medical center. Timely palliative consultation was defined as ≥to 30 days before death. Metrics contributing one point each to the ACE scores were 1) admission to ICU within 30 days of death, 2) hospital admission more than 14 days in the last 30 days of life, 3) more than one hospital admission during the past 30 days of life,4) more than one emergency room visit during the last 30 days of life,5) death in an acute care setting, 6) initiation of a new chemotherapy during the last 30 days of life, 7)last chemotherapy within 14 days of death, and 8) hospice admission less than 3 days before death. Data were reported in a descriptive fashion and analyzed using Student's T test, Wilcoxon Scores, and chi-square analysis with Stata 14.2.
Of 147 women in 2015-2020 cohort, 59(40%) had timely referral to palliative medicine compared to 18(18%) of the 2005-2010 cohort (p<0.01). Palliative referral increased from 49% to 73% (p<0.01). The median number of days from palliative referral to death was 16 days (range 0-159) in the historical and 35 days (range 0-667) in the modern cohort (p=0.02). Median ACE scores were 2 (range 0-5) for late/no referral verses 0 (range 0-4) for timely consultation (p<0.01) in 2015-2020 and 2 (range 0-6) for late/no referral verses 0 (range 0-3) for timely consultation (p=0.02) in 2005-2010. In the 2015-2020 cohort there was a significant decrease in incident metrics of new chemotherapy in the last month of life, chemotherapy in last 14 days of life, death in an ICU, and death in an acute care setting (p<0.05) (Table 1). There was also a nonsignificant trend of decrease in women who received cardiopulmonary resuscitation at the end of life for women who had timely palliative medicine consultation in the 2015-2020 cohort, 5% verses 16% (p=0.06). The median time from hospice to death in the historical group was 29 days (0-149) and 59 days (0-610) in the modern group (p=0.02). There were significant differences in age, race, insurer, disease site, stage and marital status between patients with timely verses untimely/no consultation (p<0.05).
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There has been an increased consultation frequency and proportion of timely referrals to palliative medicine comparing contemporary to historical deaths from gynecologic malignancies. In both time periods overall ACE scores and some component scores were improved for women who received timely referral to palliative medicine. These data should be interpreted with caution secondary to baseline differences in cohorts who received timely palliative consultation verses untimely/no consultation
Abstract The application and interview process for gynecologic oncology fellowship is highly competitive, time-consuming and expensive for applicants. We conducted a survey of successfully matched ...gynecologic oncology fellowship applicants to assess problems associated with the interview process and identify areas for improvement. All Society of Gynecologic Oncology (SGO) list-serve members who have participated in the match program for gynecologic oncology fellowship were asked to complete an online survey regarding the interview process. Linear regression modeling was used to examine association between year of match, number of programs applied to, cost incurred, and overall satisfaction. Two hundred and sixty-nine eligible participants reported applying to a mean of 20 programs range 1–45 and were offered a mean of 14 interviews range 1–43. They spent an average of $6000 $0–25,000, using personal savings (54%), credit cards (50%), family support (12%) or personal loans (3%). Seventy percent of respondents identified the match as fair, and 93% were satisfied. Interviewees spent a mean of 15 0–45 days away from work and 37% reported difficulty arranging coverage. Linear regression showed an increase in number of programs applied to and cost per applicant over time ( p < 0.001) between 1993 and 2016. Applicants who applied to all available programs spent more ( p < 0.001) than those who applied to programs based on their location or quality. The current fellowship match was identified as fair and satisfying by most respondents despite being time consuming and expensive. Suggested alternative options included clustering interviews geographically or conducting preliminary interviews at the SGO Annual Meeting.
How do the most successful school library media specialists play a leading role in student achievement in their schools? Jo Ann Carr and AASL share behind-the-scenes details and best practices, ...including how and why top programs succeed, get funding, and become integral contributors in their school communities.
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